Stepwise approach for side-to-side isoperistaltic colosigmoid anastomosis

In hand-assisted surgery, the surgeon can insert a hand through the small incision in the abdomen and inserts his/her hand into the patient’s body, using it for sensory perception and to guide surgical instruments. Hand-assisted laparoscopic surgery is the use of the non-dominant hand intra-abdominally. The objective of this film is to show the entirely hand-assisted intra-abdominal anastomosis technique between the transverse colon and the sigmoid colon after segmental resection of the splenic flexure.

Create account

Browse the WORLD

Virtual University

Google translate

Summary
Chapters
Your comments
Ask the Experts

You need to log in to watch this media!

Click here to log in.

Stepwise approach for side-to-side isoperistaltic colosigmoid anastomosis

Authors

J Leroy, J Marescaux

Abstract

In hand-assisted surgery, the surgeon can insert a hand through the small incision in the abdomen and inserts his/her hand into the patient’s body, using it for sensory perception and to guide surgical instruments. Hand-assisted laparoscopic surgery is the use of the non-dominant hand intra-abdominally. The objective of this film is to show the entirely hand-assisted intra-abdominal anastomosis technique between the transverse colon and the sigmoid colon after segmental resection of the splenic flexure.

Classification

tips and tricks

Keywords

Stepwise approach for side-to-side isoperistaltic colocolic transverse anastomosis

Media type

Surgical video

Duration

06'20''

Publication

2009-05

Popular

Favorites

Favorites Media

Audio

Subtitles

E-publication

WeBSurg.com, May 2009;9(05).
URL: http://www.websurg.com/doi-vd01en2640.htm

Stepwise approach for side-to-side isoperistaltic colosigmoid anastomosis

1. Introduction 00'15''

The objective of this film is to show the entirely hand-assisted intra-abdominal anastomosis technique between the transverse colon and the sigmoid colon after segmental resection of the splenic flexure. When performing such an anastomosis, it is essential to attach two bowel segments together in either an anisoperistaltic or isoperistaltic position.

2. Isoperistaltic approximation 00'44''

Here this is the isoperistaltic position anastomosis, which is being used. The wire is passed so that a pulley is made; hence during traction, this helps to avoid division of tissues. Extra- or even intra-corporeal knots can be tied. The advantage of the extra-corporeal knot is that it is quicker to perform and allow for an easy traction. The two bowel segments are re-approximated by positioning the anterior taenia each one facing each other. Thanks to the landmark thread, the length of the anastomotic area can be assessed and above all, linear traction can be placed on the taenias. The seromuscular plane is first opened using a monopolar electrode; here the roticulator mini-shears are used. The seromuscular plane is therefore divided and the submucosal vessels are electrocoagulated in an elective fashion by using a very low voltage (about 15 Watts). On the taenia of the transverse colon, the same technique is used, first on the seromuscular plane with electrocoagulation of the submucosal vessels, then mucosal division is achieved. The division is performed under visual control and the staining of the mucosa is checked.

3. Posterior plane anastomosis 02'20''

The first plane carried out between the 2 landmark threads used to attach the 2 bowel segments is the posterior plane. To do so, a monofilament absorbable thread is used. Here 2/0 PDS material is used. Maxon 3/0 material may also be used. Then we go extramucosal. The needle holder may be further rotated in order to achieve an angled approach perpendicular to the colonic wall. The needle holder may be rotated like a screwdriver in order to make the most of the full strength of the instrument. A rotation in the axis of the instrument is achieved. This helps to precisely push the tip of the needle. The different knots are made before placing traction. Since we use a monofilament thread, traction can be carried out once several needle passages are achieved, which is not possible using a braided thread; the risk being to tear tissues during traction and the thread can sometimes get caught during traction. The final corner stitch is made and the next to last loop is kept to be used as a second thread to tie the knot. The Aberdeen termination suturing technique could also be used (that is an internal tie to a convenient tail or a slipping loop tied to itself), which is not as practical and as quick as tying a knot the way we do it here.

4. Anterior plane anastomosis 04'32''

The anterior suturing will be performed using two half-running sutures starting from the left to the right to join the suturing area in the middle. The running suture to the left is carried out from cranially to caudally with passage of the needle from the sigmoid colon to the transverse colon. Several threads are passed until the medial segment of the anterior anastomosis. The running suture to the right catches the right angle between the transverse colon and the sigmoid colon. The loop is looped. Then the needle is passed from caudad to cephalad, namely from the transverse colon towards the sigmoid colon. This is achieved in order to bring the first and second thread facing each other so that closure of the anastomotic region is completed using a completely flat, plication-free knot.

5. Check of anastomosis 06'15''

A final check of the sutured area is undertaken before the mesenteric defect is closed.